Antimicrobial resistance a global threat as Kenya marks awareness week

Members of the AMR Surveillance Pilot Study among chicken layering farmers within Kiambu County disinfect theirs shoes after getting into a chicken farm to collect samples to be analyzed in a laboratory in a farm near Gatundu, Kiambu Conty, Kenya on August 15, 2019. Antimicrobial resistance (AMR) presents a multidimensional threat to the achievement of the global sustainable development goals. Drug-resistant bacteria can circulate in human beings and animals, through food, water and the environment. Understanding the extent of AMR in livestock production and aquaculture is an important basis for driving actions and is crucial to measure impacts of initiatives made in addressing this problem. [FAO Kenya] Dr John Kariuki could easily have been one of the 1.27 million people who died from Antimicrobial Resistance (AMR) in 2019. Dr Kariuki, a veterinarian, acquired an infection from hospital, and his life changed for good. "I was very close to death, and when I eventually managed to treat it, it was almost too late, I am now living with disability thanks to AMR," he narrates. Kariuki adds that instead of spending US$5,000, "I ended up spending US$35,000. This is something that could have been avoided if prevention measures were taken in good time," he says. According to the World Health Organization (WHO), AMR occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial agents. As a result of drug resistance, antibiotics and other antimicrobial agents become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness and death. World Antimicrobial Awareness Week (WAAW) is marked annually from November 18th to 24th. During this period, the Ministries of Health, Environment, Climate Change and Forestry, Mining, blue economy and maritime affairs and Agriculture and Livestock together with other stake have collaborated to work around the theme for this year: "Educate, Advocate, Act Now". This theme was chosen based on feedback from an online survey among stakeholders from the human, animal, plant, and environmental health sectors, which collected nearly 200 responses globally. Antimicrobial resistance (AMR) is not only a pressing global health and socioeconomic crisis. It also has significant impacts on human and animal health, food production and the environment. The World Bank estimates that AMR could result in US$ 1 trillion additional healthcare costs by 2050, and US$ 1 trillion to US$ 3.4 trillion gross domestic product (GDP) losses per year by 2030. Dr Loice Ombajo, an infectious disease specialist at the University of Nairobi says AMR is a global threat, but it is worse in low- and middle-income countries due to the financial burden it imposes on people living in these countries. "If we are not able to treat them because they are resistant to drugs, the cost of care becomes expensive and people die. We are in a crisis and we should begin to act now to curb AMR," she warns. Dr Ombajo observes that the most common cases of AMR occur through the over use and misuse of antibiotics, which many people buy over the counter. "We must learn to use antibiotics properly. Don't buy antibiotics over the counter, they should only be prescribed by a qualified doctor. You should also finish your dose whenever you are on antibiotics and don't take left over antibiotics." According to the World Health Organization (WHO), AMR occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial agents. [iStockphoto] Another cause of AMR is using antibiotics wrongly. According to Ombajo, statistics show that many people use antibiotics to treat colds and flus which are caused by viruses. "Antibiotics kill bacteria and not viruses, so when you take antibiotics for a sore throat you are making the bacteria in your body to become resistant to drugs such that if you get sick and require antibiotics, it will be hard to treat them," she explains. Dr Romona Ndanyi, the deputy director of veterinary services in the Ministry of Agriculture and Livestock reiterates that drug-resistant-pathogens pose a threat to everyone, everywhere. Yet, much more can be done to raise public and stakeholder awareness. She emphasizes that antibiotics must be used properly even on animals since many of these pathogens could easily end up on our dining tables. According to Dr Romona, there is a period of time you have to wait before you sell or consume the meat or milk from animals that have been treated with antimicrobials. "Dairy farmers should wait for at least 3 days from the last day that the antimicrobial has been given. Livestock and chicken farmers should stay at least 30 days before selling or consuming the meat," she advices. Dr. Romona explains that AMR that is transmitted by animals can be prevented by training farmers on food husbandry, and farm hygiene to ensure that animals are properly fed. She adds that people should follow the appropriate Water, Sanitation and Hygiene (WASH) procedures across all sectors to prevent infections. "Even the water we give animals should be clean. We should also vaccinate our animals to prevent diseases. Everybody should take action and realize that it is a global health concern. Our political leadership should realize that they are also vulnerable to AMR." The 2022 Global Antimicrobial Resistance and Use Surveillance System (GLASS) report highlights alarming resistance rates among prevalent bacterial pathogens. Median reported rates in 76 countries of 42% for third-generation cephalosporin-resistant E. coli and 35% for methicillin-resistant Staphylococcus aureus are a major concern. For urinary tract infections caused by E. coli, 1 in 5 cases exhibited reduced susceptibility to standard antibiotics like ampicillin, co-trimoxazole, and fluoroquinolones in 2020. This is making it harder to effectively treat common infections. "For us to be able to tackle AMR, we have to use the one health approach One Health refers to an integrated, unifying approach that aims to achieve optimal and sustainable health outcomes for people, animals and ecosystems," she says. According to WHO, Tuberculosis (TB) is also a major contributor to antimicrobial resistance. Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to isoniazid and rifampicin, the two most effective first-line TB drugs. Only about 2 in 5 people with drug resistant TB accessed treatment in 2022. According to Dr. Romona, AMR is a complex problem that requires both sector-specific actions in the human health, food production, animal and environmental sectors, and a coordinated approach across these sectors. "One Health refers to an integrated, unifying approach that aims to achieve optimal and sustainable health outcomes for people, animals and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants and the wider environment are closely linked and inter-dependent," says Dr. Romona. The One Health approach to preventing and controlling AMR brings together stakeholders from relevant sectors to communicate and work together in the design, implementation and monitoring of programmes, policies, legislation and research to mitigate AMR and attain better health and economic outcomes.

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